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Investments in the education and health of children are critical to the nation's future, as the nation's security and well-being depend on a productive citizenry. While families play the essential role in nurturing their children, the federal government has traditionally provided aid to disadvantaged children and families. However, federal spending on current health care and retirement programs--Medicaid, Medicare, and Social Security--is projected to grow dramatically and absorb an increasing share of the federal budget and economic output. Absent meaningful changes, little room will be left in the federal budget to address other priorities, including programs designed to assist and ensure opportunities for disadvantaged children and families. GAO convened this forum on June 25, 2008, to identify key areas of concern related to disadvantaged children and their families and to discuss ideas to address these concerns within this fiscal environment.

The following themes were highlighted by participants: (1) Improve income supports to families--Participants noted a range of issues facing some families and their children, including intermittent work, low-wage jobs, and deep poverty. This raised concerns that many children face significant instability in their lives, such as frequent moves, changing child care arrangements, and unstable family incomes. Some participants asserted that work and income supports to families help reduce the negative effects of poverty on children. However, it was noted that existing work and income supports don't help everyone, and that policymakers need to find ways to better assist the most vulnerable groups in order to stabilize their lives and reduce the harmful effects of these circumstances on children. (2) Focus on health care services and prevention--Participants noted the important role that health care services play in ensuring opportunities for all children. They raised concerns about the lack of health care coverage for a significant portion of people, citing health insurance costs as a growing burden for workers, businesses, and government. They also suggested the need to revamp the health care system, including payment policies, to ensure that health care professionals help prevent illness and disease. (3) Expand educational opportunities--Participants pointed to the need for increased opportunities for early, secondary, and postsecondary education to support the long-term success of disadvantaged children. Concerns were raised that low-income children are less likely to get quality early care and education services, stay in school, or acquire postsecondary education. This is due, in part, to challenges faced in affording quality child care, being English language learners, and navigating college application and financial assistance processes. (4) Restore fiscal health to the federal budget--A presentation by one participant suggested that slowly changing the allocation of federal resources from retirement programs to programs focused earlier in the life cycle of individuals, such as education, could yield brighter futures for individuals and less reliance on federal support in later years over the long run. This increased focus on prevention would help address projected deficits and improve well-being among some children and families, noting that child well-being in the United States ranks below that of several other rich countries. (5) Use the federal budget process, research, and data to make federal investment decisions--Some participants suggested that policymakers examine how to enable federal budget deliberations to discuss funding in terms of long-term investments versus current consumption so that policymakers can make explicit choices about the right mix of each. Others discussed the need for research and national indicators--and using the results of these--to direct federal investments to programs and interventions that work. Overall, the discussion highlighted that doing more to ensure all children have opportunities to become productive citizens--through income support, health care, and education policies--will require new thinking about federal investments with an increased focus on prevention and longer term investments.